Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain; Health Research Institute Galicia Sur, Vigo, Spain.
Department of Cardiology, University Hospital Álvaro Cunqueiro, Vigo, Spain.
Arch Cardiovasc Dis. 2022 Aug-Sep;115(8-9):448-456. doi: 10.1016/j.acvd.2022.05.006. Epub 2022 Aug 8.
Atrial fibrillation (AF) carries a thrombotic risk related to blood stasis in the left atrium. In patients with rheumatic valve disease and AF, the presence of severe mitral regurgitation (MR) has been shown to reduce the risk of atrial thrombosis and stroke. However, in patients without rheumatic disease, the results are controversial.
To analyse the association between MR and the incidence of stroke in patients with non-rheumatic AF.
We analysed data from the retrospective CardioCHUVI-AF registry, which includes 15,720 patients with AF (without mechanical prostheses or rheumatic valvular disease) in the Vigo area of Spain, during 2014-2018. We grouped the patients according to MR grades: 0-2 (n=15,194) and 3-4 (n=526). We performed univariate and multivariable competitive risk analyses to analyse the association between MR and stroke, with death as the competitive event.
During a median (interquartile range [IQR]) follow-up of 4.9 (2.8-4.9) years, 859 patients (5.5%) suffered a stroke. The stroke incidence was 1.3 per 100 person-years (95% confidence interval [95% CI]: 1.2-1.4), with no difference between the MR groups. In univariate analysis, no relationship was observed between MR grade and stroke (subdistribution hazard ratio [sHR]: 1.12, 95% CI: 0.79-1.60; P=0.53); likewise after multivariable analysis (sHR: 0.98, 95% CI: 0.68-1.41; P=0.90). This same relationship was evaluated in subgroups of interest (patients with and without: oral anticoagulation, CHADS-VASc≥2, prior heart failure, aortic valve disease, left ventricular ejection fraction≤40%, and moderate-severe left atrial dilation), with results consistent with the overall population.
In our large registry of patients with non-rheumatic AF, we did not find a protective effect of grade 3-4 MR on the risk of stroke.
心房颤动（AF）存在与左心房血瘀相关的血栓形成风险。在风湿性瓣膜病合并 AF 的患者中，严重二尖瓣反流（MR）的存在已被证明可降低心房血栓形成和中风的风险。然而，在没有风湿性疾病的患者中，结果存在争议。
分析非风湿性 AF 患者中 MR 与中风发生率之间的关系。
我们分析了来自西班牙维哥地区 2014-2018 年 CardioCHUVI-AF 回顾性登记研究的数据，该研究纳入了 15720 例无机械假体或风湿性瓣膜病的 AF 患者。我们根据 MR 分级将患者分为 0-2 级（n=15194）和 3-4 级（n=526）。我们进行了单变量和多变量竞争风险分析，以分析 MR 与中风之间的关系，以死亡为竞争事件。
在中位（四分位距 [IQR]）随访 4.9（2.8-4.9）年期间，859 例患者（5.5%）发生中风。中风发生率为 1.3 例/100 人年（95%置信区间 [95%CI]：1.2-1.4），两组之间无差异。在单变量分析中，MR 分级与中风之间未见相关性（亚分布危险比 [sHR]：1.12，95%CI：0.79-1.60；P=0.53）；同样在多变量分析后（sHR：0.98，95%CI：0.68-1.41；P=0.90）。在感兴趣的亚组（接受或未接受口服抗凝治疗、CHADS-VASc≥2、既往心力衰竭、主动脉瓣疾病、左心室射血分数≤40%和中重度左心房扩张的患者）中评估了这种关系，结果与总体人群一致。
在我们的大型非风湿性 AF 患者登记研究中，我们未发现 3-4 级 MR 对中风风险有保护作用。
